A prospective study of viral hepatitis A and the question of chronicity.

In a prospective study, the author followed up the course of hepatitis A (HA) in 451 patients, predominantly schoolchildren, who were treated in the years 1982-1985 in the Department for Infectious Diseases of the Celje Municipal Hospital. HA was identified by the present of hepatitis A virus IgM class (anti-HAV-IgGM) in the serum, and in one-third of the patients (38.6%) also with serological proof of the presence of the hepatitis A virus antigen (HAAg) in the feces. Other liver diseases which might present a similar picture were excluded. In 378 patients (83.8%) the course of the disease was mild, the biochemical "liver tests" normalised within three months; in 73 patients (16.2%) the course was prolonged up to twelve months. In eight patients with a relapsed or protracted course that lasted from six to twelve months after the normalization of clinical and biochemical results, a liver biopsy was performed. The histologic picture revealed only slight residual changes which were evident mainly in portal and periportal areas of the liver. All of the HA convalescents were free of subjective signs and had no clinical symptoms after two to three years. In 23 patients (5.1%) posthepatitic indirect hyperbilirubinemia remained a laboratory finding. On the basis of our results, we came to the conclusion that, also in patients with a protracted and relapsed course, HA takes a benign course which in itself tends toward recovery and does not leave any permanent sequelae in the liver.